<div class="middlebg">

	<div id="component">
		<form name="mosForm" method="post"
			action="<?= $this->baseUrl('/site/registration/') ?>">

			<div class="componentheading">Registration</div>

			<table width="100%" cellspacing="0" cellpadding="0" border="0"
				class="contentpane">
				<tbody>
					<tr>
						<td colspan="2">Fields marked with an asterisk (*) are required.</td>
					</tr>
					<tr>
						<td>Username: *</td>
						<td><input type="text" maxlength="25" class="inputbox" value=""
							size="40" name="username">
						</td>
					</tr>
					<tr>
						<td>E-mail: *</td>
						<td><input type="text" maxlength="100" class="inputbox" value=""
							size="40" name="email">
						</td>
					</tr>
					<tr>
						<td>Password: *</td>
						<td><input type="password" value="" size="40" name="password"
							class="inputbox">
						</td>
					</tr>
					<tr>
						<td>Verify Password: *</td>
						<td><input type="password" value="" size="40" name="password2"
							class="inputbox">
						</td>
					</tr>
					<tr>
						<td colspan="2"></td>
					</tr>
					<tr>
						<td colspan="2"></td>
					</tr>
				</tbody>
			</table>
			<input type="button" class="button" value="Send Registration" onclick="submit()">
		</form>
	</div>

</div>
